HOW’S THE NEW HEALTHCARE PROGRAM GOING FOR YOU?

A candid Q & A with Elson M. Haas MD

Q:  So, Dr. Haas, now that we are several months into the Affordable Care Act, what is your assessment from a provider’s point-of-view?

A:  Well, so far as I can tell, no one’s very excited about the ACA (“Affordable Care Act”), including me, my associates, and my patients. Many are paying too much for poor coverage.

 

Q:  Not excited?  Why is that?

A:  It seems that insurance companies are now covering less, including fewer doctors on their plans and being subsidized by taxpayers in the process. Many are paying more for an inferior product; we don’t like that in America.

 

Q:  If that’s the case, what are the consequences at your clinic?

A:  The first thing we noticed was that our reimbursements for the new plans are reduced by about 30-40 percent for our patient visits.  As you can imagine, this has had a huge and negative impact upon our clinic operations.  We also noticed that a number of our patients who were previously covered found out that they were no longer covered when they came to us for care.

 

Q:  Your patients who were previously covered found out that they weren’t able to see you anymore and be covered by insurance!?  How did that happen?

A:  Good question—the only thing we know is that I was, and am an Anthem Blue Cross provider (for example), and when my patients who were previously covered by this plan moved to Covered California they found that their plan was now being managed by another company with very few doctors involved, and my name wasn’t on the roster. And we had no communication from Anthem about this.

 

Q:  Is this an isolated situation?

A:  No.  We have had a number of patients come into our clinic and find out to their surprise and dismay that they are no longer covered.  So the impact is multiplied—we don’t provide care, the patient doesn’t receive care, and we don’t get paid.  I don’t think that’s what the authors of the ACA had in mind.  The only thing that seems to be working is that the insurance carriers are being paid handsomely for providing less coverage.

 

Q:  This sounds like a very critical situation.  What do you see happening in the months ahead?

A:  We wish we knew.  We certainly can’t continue to operate under this broken system, especially since I feel primary care doctors using the insurance model were being underpaid before the ACA took effect.  It has been challenging enough being reimbursed for the level of integrative and preventive care we provide with little consideration for the time and effort we invest on our patients’ behalf above-and-beyond the visit. This includes phone time, prescription re-fills, weekend calls and more.  The only thing I can see is that if we are going to remain solvent as a clinic, patients are going to have to pay more and more for these services which were previously covered.

 

Q:  Dr. Haas, what message do you have for patients who are currently involved with the ACA?

A:  I would ask anyone covered under the ACA—in California or elsewhere:

How is it working for you?

What has been your experience so far?

What suggestions do you have to make insurance better?

 

I would also encourage people to read my previous blogs about this matter, in which I promote an approach where we as individuals assume a greater responsibility for our health through preventive care and healthy lifestyle choices, and keep our “insurance” focused on coverage for catastrophic events and serious injuries.

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If you have thoughts you would like to share with Dr. Haas about the ACA, please leave comments below.

 

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Patient Protection and Affordable Care Act is a Small Step Forward in Fixing Our “Disease Care System”

Preventitive care with ObamacareAllow me to share few thoughts here about our country’s new Patient Protection and Affordable Care Act (PPACA).

PPACA is primarily an insurance reform bill that promises benefits such as lower prices, some preventive health care support, and guarantees insurance for people with pre-existing conditions. It also mandates that young adults under 26 years old can stay on their parent’s health care plan and that restaurant chains post calorie content on their menus (see more benefits here).

However, it does require that each of us purchase insurance (or pay a tax) and offers little in actually reforming the health care system we currently have, which is more literally a “disease care system.”

No matter how well received PPACA is (or isn’t), we still need massive health care reform based more on a preventive health care model rather than totally focused on “disease repair.” With a preventive model, we can support and even incentivize:

  • More personal responsibility and healthy living
  • Educating our youngsters at home and in school to make healthy choices — learning good habits early on in childhood is key to preventing many of the chronic diseases our health care system is ill-equipped to handle
  • Helping to provide our families with better access to healthier food

What’s being called Obamacare is a good start in the long overhaul necessary for major reform. No real change in our health care system has been made since Medicare and Medicaid was initiated in 1965. It’s about time we tackled one of our country’s biggest economic and social challenges.

What do you think is the first change that needs to be added to PPACA legislation?

Image courtesy of Thanks, Obamacare.org